Death at CM Tucker

Residents of a Columbia nursing home that the S.C. Department of Mental Health operates have suffered preventable deaths, injuries and illnesses because the department failed to provide them with adequate care. July 23-29, 2008

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July 23-29, 2008
Feds Allege Constitutional Violations
at State-Run Nursing Home in Columbia
BY ERIC WARD
esidents of a Columbia
nursing home that the S.C.
Department of Mental
Health operates have
suffered
preventable
deaths, injuries and illnesses because
the department failed to provide them
with adequate care.
A residential pavilion at the C.M. Tucker Jr. Nursing
Care Center, which is located at 2200 Harden St. in
Columbia. Photo by Graeme Fouste
Running afoul of generally accepted
professional standards, the inadequate
care violated rights of the residents
outlined in the Constitution and federal
law.
Those are the conclusions the U.S.
Department of Justice reached — often in
stark, ghastly terms — after investigating
practices and conditions at the C.M.
Tucker Jr. Nursing Care Center.
The Department of Mental Health
disputes the allegations by the Department
of Justice (DOJ) and asserts that the care
provided at the Tucker Center meets or
exceeds generally accepted professional
standards.
The DOJ account of Tucker, detailed in
a 36-page report dated May 6, probably
would cause the average person to feel
disturbed and avert their eyes. Scathing,
it paints a picture of a virtual house of
horrors where standards of care were so
lacking that even some residents’ basic
food and water needs went unmet.
“We find that residents of Tucker
suffer significant harm and risk of harm
due to inadequate nursing, medical and
mental health care,” the report says. Also
described in the document as inadequate
at the facility: nutrition and hydration,
behavioral programming, medical and
nursing documentation, protection from
harm, activities for its occupants and
sanitation.
“As a result of these deficiencies, Tucker
residents have suffered preventable
injuries, illnesses and deaths,” the DOJ
says.
Answering those charges, the
Department of Mental Health (DMH)
pushes back vigorously.
The DMH “takes strong exception to
cover
the assertion that Tucker residents ‘have
suffered preventable injuries, illnesses
and deaths,’” the agency says in a July 17
statement provided to Free Times. For the
most part, the case summaries the DOJ cites
are erroneous or incomplete, the statement
reads. “Ironically, when the full and accurate
facts are reviewed, many of the cases chosen
by the Department of Justice serve to
exemplify the generally good care provided
to residents at Tucker Center,” it says.
Tucker sits at 2200 Harden St. in the
heart of the city, providing long-term care to
elderly people, many of whom suffer from
severe physical and mental diseases and
disabilities.
Besides implicating the DMH, the
Department of Justice’s findings raise serious
questions about accountability and oversight
of the state agency and the S.C. Department
of Health and Environmental Control
(DHEC), which licenses public and private
nursing homes in the state, inspects them
annually and issues reports based on the
inspections.
The questions about Mental Health and
DHEC relate to how the agencies are governed
and where the buck stops with them.
homes when inspecting them, according to a
May 15 report in The New York Times.
Meanwhile, ominous news out of Tucker
keeps coming.
Most recently, 87-year-old Tucker resident
Theodore Howell was found dead in the
early morning hours of July 17, hanged
with a necktie. “He was unresponsive when
they found him,” Richland County Coroner
Gary Watts says, adding that he is unsure
whether Howell committed suicide. “We’re
investigating it heavily.”
Watts says Tucker and the DMH are
cooperating.
Likewise, the Department of Justice
report thanks the state and Tucker for their
“complete cooperation and assistance” in the
DOJ probe.
Partly because of that helpfulness, the
federal agency’s findings surprised and
disappointed the DMH, says the agency’s
general counsel, Mark Binkley.
One of the big questions the DMH faces is
what happens next.
The DOJ investigated C.M. Tucker under
the federal Civil Rights of Institutionalized
Persons Act. The DOJ says the law gives
Justice authority to pursue a remedy “for a
July 23-29, 2008
divergent explanations for a deadly serious
situation.
Often in such circumstances the truth lies
somewhere in the middle.
Is that the case with Tucker?
Probably, says Gloria Prevost, director of
Protection and Advocacy for People with
Disabilities, a statewide private, nonprofit
organization with federal and state authority
to carry out its mission.
The sheer size of C.M. Tucker raises
concerns, Prevost says. Serving about 400
residents, Tucker is extraordinarily large
compared to most nursing homes in South
Carolina and across the nation, she says. “It’s
very sad in this day and age that there are
places that large.”
In that regard, the DOJ’s depiction of
Tucker reads like something out of America’s
muckraking era of the late 19th and early
20th centuries, when investigative reporters,
novelists and critics exposed hideous
conditions in certain prisons, factories and
other locations.
The treatment in this country of people
institutionalized with mental and physical
disabilities has come a long way from the
muckraking period.
21
obstructive pulmonary disease.
In some instances, Justice characterizes
the allegedly woeful care at Tucker as
egregious, using that term in reference to
a resident who, as a result of inadequate
pain medication, was found “‘groaning in
the fetal position’ as death approached.
Another resident, dying of [spreading]
colon cancer, vomited blood several times
in the hours before his death, but no nausea
medication was requested by the nurse on
duty. Moreover, even though a tranquilizer
had been ordered for this resident, it was
not administered, a violation of generally
accepted professional standards.”
In addition, the DOJ holds that the
Department of Mental Health fails to serve
Tucker residents in the most community
integrated setting possible, leading to
some people being confined to the facility
unnecessarily.
In summary, the DOJ says, “We conclude
that numerous conditions and practices at
Tucker violate the constitutional and federal
statutory rights of its residents.”
Those rights include adequate health care
under due process provisions of the 14th
Amendment, and protections outlined in
“It’s very sad in this day and age
that there are places that large.”
— Gloria Prevost, director of the statewide nonprofit Protection and Advocacy for People with Disabilities,
on the local C.M. Tucker Jr. Nursing Care Center, which houses about 400 people
As for the inspection reports, they
are public documents just like DHEC’s
write-ups on examinations of food-service
establishments the agency conducts at least
once yearly. Dubbed restaurant report cards,
they are available on the DHEC web site.
“They are searchable by address, county
and facility name,” says Adam Myrick, a
spokesman for the agency.
However, DHEC’s nursing home
inspection reports, which can help people
find quality care for their elderly loved
ones and avoid troubled facilities, are not
accessible online.
Free Times asked DHEC for copies of
its inspection reports on Tucker for 2005
through 2008, if one has been compiled for
this year.
Without those documents it is almost
impossible to compare what if anything
DHEC turned up with what the DOJ found.
But DHEC said it would release them only
via a written request pursuant to the state
open-records law, the S.C. Freedom of
Information Act.
Such a request is pending.
Among other concerns with DHEC, the
federal Government Accountability Office
conducted an inquiry in which it found that
South Carolina was among the states most
likely to miss serious problems at nursing
pattern or practice of conduct that violates
the constitutional or federal statutory rights
of nursing home residents” in a public
facility.
The feds cannot fine or otherwise punish
Tucker or the DMH. But the DOJ can take
the state to federal court and try to convince
a judge to order South Carolina to improve
care at the nursing home.
Both parties say they want to avoid that
outcome.
“In general, if a state is responsive to
our findings, we attempt to work out a
mutually agreeable settlement to resolve the
unconstitutional conditions identified in our
findings letter,” DOJ spokeswoman Jamie
Hais says in an email. “The type of settlement
we enter depends upon a number of factors,
including the severity of the issues we
uncovered and the jurisdiction’s cooperation
and ability to resolve the problems.”
Says Binkley, “I’m optimistic we can resolve
this without litigation.” With that in mind the
DMH is talking with Justice, he says.
Whom to Believe?
For the objective observer, the conflicting
federal and state accounts of Tucker are
analogous to two siblings offering wildly
Still, the DOJ investigation suggests that
vestiges of it linger.
The feds charge that the deaths of four
residents at C.M. Tucker might have been
avoided but for substandard care. The DOJ
report does not identify them by name.
One of them, a man, died of pneumonia at
a local hospital after suffering “inadequately
and untimely assessed swallowing problems,
improper diet and untreated loss of 20
percent of his body weight over a fourmonth period” at Tucker, the report reads.
Poor care of the man deprived him of “a safe
method by which to eat, the muscle strength
and stamina needed to adequately chew and
swallow safely and, ultimately, the ability
to cough effectively to clear his lungs and
recover” from the pneumonia, it says.
In an equally long rebuttal to the DOJ
report — a 36-page response dated July 9
and signed by general counsel Binkley —
the DMH refutes the feds’ charges point by
point, giving little ground.
Regarding the man’s death, Mental Health
says he “did not have a swallowing problem
so a regular diet was not improper and the
bulk of his weight loss occurred while he
was in a local hospital, from which he was
discharged 10 days prior to his death.” His
passing, the DMH contends, resulted from
respiratory failure stemming from chronic
the Civil Rights of Institutionalized Persons
Act and the Americans with Disabilities Act,
according to the DOJ.
Running defense on the alleged egregious
case of inadequate pain medication, the
DMH says Tucker has been at the forefront
in pain treatment and end-of-life care.
The nursing home maintains a pain
management quality improvement team that
has developed policies and other measures
tailored to meet residents’ needs in this
area, as well as a hotline to report pain
management concerns, Mental Health says,
adding that:
• Tucker has a contract with the local
Hospice Care of Tri County company,
which provides individualized, 24-hour
services to the facility’s terminally ill
residents.
• The number of Tucker occupants
receiving pain medication around
the time of the DOJ probe was more
than twice the state benchmark and
is increasing while the state standard
remains the same.
As a general endorsement of Tucker,
the DMH notes that the nursing home is
certified by the Centers for Medicare and
Medicaid Services, a requirement to receive
payment from those federal programs.
Additionally, Mental Health points out
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July 23-29, 2008
that the Tucker Center is accredited by the
Illinois-headquartered Joint Commission,
which describes itself as “the world leader
in evaluating the quality and safety of care”
at some 15,000 health care facilities in the
United States. The Joint Commission last
conducted an on-site inspection of Tucker in
July 2006, four months before the DOJ first
did.
The Department of Justice also accuses
Tucker of inappropriately using restraints
— physical, mechanical or chemical — to
control the behavior of some residents.
“Thus, restraints are used for the
convenience of staff and not for emergency
intervention to protect individuals from risk
of harm, in violation of residents’ federal
rights,” the Justice report says.
The DMH disagrees, saying restraint use
at Tucker is below the national average, a fact
that “evidences the facility’s commitment to
ensure residents the highest practicable level
of physical freedom of movement.”
Another DOJ charge relates to pressure
sores. Also called bed sores, they result from
a lack of blood supply and are common in
people who are bedridden.
“We found that Tucker substantially
departs from the standard of care for
avoiding pressure sores,” Justice says.
“Several Tucker residents suffered severe
stage [four] pressure sores that should
have been prevented with appropriate
care, including regularly turning and
repositioning the resident.”
The DMH contests that allegation, too.
“Unlike the majority of community
nursing homes, Tucker Center has had a fulltime certified wound care nurse since 2003,”
the state agency counters. Not only that, the
occurrence of pressure sores at Tucker is
below the national average, “supporting our
belief that the wound care program at Tucker
Center is vigilant, responsive and highly
effective,” says the DMH response.
Carolina. “Anytime you have a situation
like that there’s not going to be as much
accountability as there should be,” he says.
Sanford has proposed making both the
DMH and DHEC a part of the governor’s
Cabinet, mainly for greater accountability
and cost savings.
In the federal Government Accountability
Office (GAO) inquiry into state nursing
home inspections, South Carolina was one
of nine states that failed to catch serious
problems in more than 25 percent of the
inspection surveys the GAO analyzed,
according to The New York Times story.
Regardless of the veracity of the DOJ
says the vastness makes providing nursing
home residents with activities in such
circumstances difficult and it often doesn’t
happen.
That is one of the few DOJ points that
Mental Health concedes. “Tucker Center
agrees with the premise by Justice that
more opportunity for therapeutic and social
activities is desirable,” the state agency’s
response says.
Similarly, the DMH concedes that Tucker
might not be the most appropriate setting
for some of its residents. However, Mental
Health says, “Some residents at Tucker
have challenges which no other nursing
Another pavilion where Tucker
Center residents live. Photo by
Graeme Fouste
Accountability Lacking
The DOJ report is addressed to Gov.
Mark Sanford. In the document, Justice
says it inspected Tucker in November and
December 2006 with expert consultants
in the areas of protection from harm,
environmental health and safety, geriatric
medicine, psychiatry and nursing. DOJ
personnel also visited the nursing home in
September, without experts.
The investigation included interviews with
Tucker administrators, staff and residents
and a review of reams of documents from
the facility.
For his part, Sanford took the allegations
very seriously, says his spokesman, Joel
Sawyer. “And we found its contents very
unsettling,” Sawyer says. “DMH has already
acknowledged that some of what is in the
report needs to be addressed.”
Yet because of the structure of state
government, the governor can do little about
Tucker, as neither the DMH nor DHEC are
Cabinet agencies. Instead, they answer to,
respectively, a commission and a board.
Responding to questions, Sawyer says five
or six agencies can be involved in nursing
home regulation and accountability in South
report, even the hardest heart breaks at the
C.M. Tucker Jr. Nursing Care Center.
In various ways it has long been said that
the moral standing of a society can be judged
by how that culture treats its most vulnerable
members.
By that standard, even if Justice’s
allegations are untrue, South Carolina has a
long way to go to when it comes to Tucker.
Returning to the issue of the size of the
facility, some people who look upon it might
say it warehouses elderly folks.
Protection and Advocacy director Prevost
home in the state is willing to address,
despite the resident meeting long-term
placement criteria. These challenges include
Huntington’s disease, head and spinal cord
injuries and chronic mental illness.”
Challenges is an understatement.
Huntington’s disease is a severely
disabling central nervous system disorder,
symptoms of which include uncontrollable
body movement.
Says the DOJ, “Tucker is the nursing
home of last resort for hundreds of patients
with long-term psychiatric illnesses.”
Says Mental Health, “Alternative
community placements for these residents
are very limited or nonexistent.”
Very true, Prevost says. “But I think that is
not acceptable in this day and age.”
She says Protection and Advocacy has
not received calls about abuse and neglect at
Tucker in the recent past. But, Prevost says,
“We have gotten calls from people [residing
at Tucker] who have said I would like to
live in the community.” The organization is
working with some of the residents toward
that end, she says, adding that getting people
out of Tucker who don’t need to be there
is one of her biggest concerns about the
nursing home.
As a few of the cases mentioned indicate,
sometimes the Tucker Center is where
people go to die.
“They are depressing places,” Prevost says
of nursing homes.
The aesthetics of Tucker don’t exactly help
matters — a series of nondescript, onestory tan brick buildings covering nearly 50
acres across Harden from the former State
Hospital campus.
Grassy grounds lined with trees and
shrubbery add a vibrant element to the
Tucker environment, but there’s no escaping
the nature of the place. Drive past one of its
three residential pavilions and one might
catch a glimpse, through large glass doors
and windows on the front side, of a roomful
of elderly people sitting in wheelchairs, some
with their heads sagging.
Breezy quiet blankets Tucker around
lunchtime on July 16. Employees in variously
colored nursing garb meander here and
there.
A series of roads — some needing paving,
all reading speed limit 20 — crisscross the
grounds. A security detail patrols the area in
an unmarked gray squad car.
Outside the Roddey Pavilion at the
eastern edge of Tucker, U.S. and South
Carolina flags flap in the breeze. Inside
Roddey is an enclosed admissions and
information desk with a sign taped to a
sliding-glass reception window. The sign
displays a State Law Enforcement Division
abuse hotline number and internal numbers
to call to report abuse at each of the
pavilions.
Opposite Roddey an ambulance idles in
front of the E. Roy Stone Jr. War Veterans
Pavilion, home to people who have served
their country in arms and the first building
one encounters when turning onto the
Tucker property.
For some residents of the nursing home,
an ambulance ride out of Tucker was their
last journey in this life. But whether that
was because of negligent care at the facility
or simply a result of natural causes remains
in question. What seems indisputable —
what breaks a heart — is the indignity
of warehousing the least of these in their
twilight years.
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